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Legalities in End-of-Life Care: AMA & RWJF Initiative

Explore legal consensus points and myths in end-of-life care. Understand laws, ethics, informed consent, treatment limitations, and advance directives. Learn about opioid use, physician-assisted suicide, futility, and legal counsel risks.

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Legalities in End-of-Life Care: AMA & RWJF Initiative

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  1. The Project to Educate Physicians on End-of-life CareSupported by the American Medical Association andthe Robert Wood Johnson Foundation Legal Issues Plenary 2

  2. Objectives • Describe legal consensus points • List common legal myths and potential pitfalls

  3. Law and ethics– United States • Federal vs State • Lawmakers • legislatures, judges, executive agencies • Enforcement • criminal, civil, administrative

  4. Resolving difficult cases • Law • Ethics committees / consultants

  5. Ethics ofinformed consent . . . • Information-giving standards • standard professional • reasonable person • specific patient

  6. Ethics of informed consent . . . • Elements of information • nature of procedure • risks, common or severe • benefits • alternatives

  7. . . . Ethics of informed consent • Consent • understanding • voluntary

  8. Procedures of informed consent • Documentation • Process of deliberation • Shared decision making • Communication of news • Physicians have direct responsibility

  9. Treatment limitation at the end of life • Right to refuse any intervention • All patients have rights, even incapacitated • Withholding / withdrawing • not homicide or suicide • orders to do so are valid • Courts need not be involved

  10. Determining incapacity • General incapacity • Specific incapacity • Is there a decision? • Is the information understood? • Is the reasoning logical and with appreciation for consequences? • Is the decision sensible? • Reassess for each decision

  11. Decisions for the incapacitated • Best interests • Substituted judgment • advance directives • surrogacy laws

  12. Terminology of advance directives . . . • Advance care planning • process of discussion, documentation, implementation

  13. Terminology ofadvance directives . . . • Advance directives • instructional statement • living will • values history • personal letter • medical directive

  14. . . .Terminology ofadvance directives • Statutory • physician immunity • Advisory • patient wishes • Proxy designation • health care proxy • durable power-of-attorney for health care

  15. Appropriate use of opioids in end-of-life care • Federal and state • Principle of double effect

  16. Physician-assisted suicide • United States Supreme Court 1997 • States free to develop laws

  17. Futility • Futile for what goal • Objective determinations of benefit • Use ethics consultation / committees • Transfer of care

  18. Legal counsel and risk • State-by-state variations • Hospital counsel represents the institution

  19. Legal Issues Summary

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